Genital herpes

Also called Herpes simplex, HSV

Extremely common, usually mild after the first episode, and carrying stigma far out of proportion to the illness. Dangerous only around childbirth.

What it is

Infection of the genital area with herpes simplex virus, either type 1, the usual cause of cold sores, or type 2.

It is very common. Most people who have it do not know, because they have no symptoms or symptoms mild enough to be mistaken for thrush, a cut or an ingrown hair. It is frequently transmitted by people who have no idea they carry it, which means a new diagnosis says nothing reliable about when or from whom it was acquired, or about anybody's faithfulness. That single fact defuses a great deal of unnecessary damage.

The first episode is usually the worst: painful blisters and ulcers, sometimes with fever and difficulty passing urine. Recurrences are milder, shorter and become less frequent over the years.

Antiviral tablets shorten episodes if started early, and daily suppressive treatment reduces recurrences and transmission substantially. Both are under-offered.

The situation that genuinely matters clinically is **pregnancy**. A first infection in the third trimester carries a significant risk of neonatal herpes, which can be fatal, and usually means a caesarean birth is recommended. Anybody who is pregnant, or whose partner has genital or oral herpes, should tell their midwife.

Condoms reduce but do not eliminate transmission, because the virus sheds from skin not covered.

Signs you might notice

First episode: painful blisters or ulcers around the genitals, anus or thighs; stinging or burning on passing urine; flu-like symptoms, fever and swollen glands in the groin; sometimes difficulty passing urine at all.

Recurrences: tingling, itching or burning in the same area a day beforehand; a smaller crop of blisters; healing within a week or so.

Often nothing at all.

Urgent: inability to pass urine, which happens in severe first episodes and needs medical help; severe pain; symptoms in anybody immunosuppressed; a first episode in pregnancy, particularly in the third trimester.

Emergency: any blisters, fever, poor feeding or floppiness in a newborn.

How it can affect day-to-day life

The psychological impact is usually far worse than the physical one, and it is driven almost entirely by stigma. People describe a diagnosis as devastating, then find within a year that it is a minor recurring nuisance.

Telling a partner is the part people dread. The accurate framing helps: it is extremely common, most people with it do not know, and there are effective ways to reduce transmission.

Recurrences are triggered by illness, stress, tiredness, friction and sometimes menstruation.

Suppressive antiviral treatment, taken daily, is genuinely life-changing for people with frequent recurrences and for reducing transmission to a partner, and is not offered nearly often enough.

Salt baths, passing urine in a bath or shower during a bad first episode, and simple pain relief make the acute phase tolerable.

The diagnosis is best made at a sexual health clinic by swabbing an active lesion; blood tests are of limited use and often misinterpreted.

Supporting someone well

Go to a sexual health clinic while lesions are present, so a swab can confirm it.

Start antiviral treatment early in an episode; within 48 hours makes the difference.

Ask about daily suppressive treatment for frequent recurrences or to protect a partner.

For pain: salt baths, passing urine in the shower or bath, ice packs wrapped in a cloth, and regular pain relief.

Tell a midwife if pregnant, or if a partner has genital or oral herpes.

Avoid sex during an episode and from the first tingle until healed.

Do not kiss a baby if you have a cold sore, and see cold sores.

Be accurate about what a diagnosis does and does not mean, particularly about when it was acquired.

Where to get help

A sexual health clinic, free and confidential, and the best place for diagnosis and treatment.

A GP practice, and urgently in pregnancy.

A and E for inability to pass urine, or for a newborn with blisters or fever.

Herpes Viruses Association run a helpline and are the specialist charity, with particularly good material on telling a partner.